• Bassel G Diebo, Isaac Gammal, Yoon Ha, Seung Hwan Yoon, Jae Won Chang, Byeongwoo Kim, Morio Matsumoto, Yu Yamato, Daisaku Takeuchi, Naobumi Hosogane, Mitsuru Yagi, Hiroshi Taneichi, Frank Schwab, Virginie Lafage, Christopher Ames, and International Spine Study Group (ISSG).
• Spine Service, Hospital for Special Surgery, New York, NY.
• Spine. 2017 Feb 15; 42 (4): E234E240E234-E240.

Study DesignRetrospective review of adult spinal deformity patients in a multiethnic database.ObjectiveTo investigate the role of ethnicity on recruitment of compensatory mechanisms for sagittal spinal deformity.Summary Of Background DataWhile the impacts of age, sex, and pelvic morphology on the ability to compensate for sagittal malalignment have been investigated, the role of ethnicity in compensatory mechanism recruitment is poorly understood.MethodsPatients from USA (85% Caucasian) >25 y/o were propensity matched by age, sex, and pelvic incidence with patients from Korea and Japan. Only primary patients or those with existing fusion below T12 were retained for analysis. Groups were subclassified by deformity severity (aligned: sagittal vertical axis (SVA) <50 mm; moderate malalignment: SVA 50-100 mm; severe malalignment: SVA >100 mm). Radiographic measurements including pelvic retroversion, thoracic kyphosis, loss of lumbar lordosis (PI minus LL), cervical lordosis, and cervical SVA were compared between the groups.ResultsThere were 288 patients (96 each in USA, KOR, JPN), with similar age (64-67 yr) and PI (49-53°). USA had smaller pelvic incidence minus lumbar lordosis in every alignment group (P <0.05). In moderate malalignment, JPN had more pelvic retroversion than USA (30° vs. 20°), and KOR had more thoracic hypokyphosis than USA (15 vs. 31°). In severe malalignment, JPN had more pelvic retroversion than USA (39° vs. 27°), and KOR had more thoracic hypokyphosis than USA (15° vs. 31°). KOR had smaller cSVA than USA in both aligned (11 vs. 27 mm) and moderate (19 vs. 31 mm) malalignment. In severe malalignment, KOR had less cervical lordosis (13° KOR vs. 15° USA vs. 27° JPN). All differences with P <0.05.ConclusionCompensation for sagittal is ethnicity dependent. Korean patients favor thoracic compensation via hypokyphosis, and Japanese patients favor pelvic compensation via retroversion. Patient ethnicity should be considered when evaluating the sagittal plane and surgical correction strategies.Level Of Evidence3.

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